The Role of Occupational Therapy in Acute Spinal Cord Injury

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Introduction[edit | edit source]

Rehabilitation process in the spinal cord injury is usually divided into acute, subacute and chronic phase.[1] The definition of each of the phases varies, however it is commony accepted that the natural neurorecovery process sets the timing for each phase. The acute and subacute periods lasts around 18 months post-injury, and is followed by the chronic stage when the neurorecovery has plateaued. [2] During the acute phase the focus is on:[1]

  • preventing secondary complications
  • promoting and enhancing neurorecovery
  • maximizing function
  • initiating activities leading to long-term maintenance of health and function.

The Occupational Therapists belong to the multidisciplinary team in spinal cord injury. Their role in the rehabilitation of the spinal cord injury patients include enhancing patients' daily life activity execution and fine movement, teaching how to use compensatory strategies, finding solutions for the patients' environment adaption to fulfil the common goal of achieving total social inclusion.[3]

Multidisciplinary Teams in SCI[edit | edit source]

The multidisciplinary team during the acute phase can consist of:

  1. Surgeon – spine  / neurology / orthopaedics
  2. Physician – rehabilitation, other specialists (intensivist and neurologist)
  3. Nurse
  4. Physiotherapist
  5. Occupational therapist
  6. Speech Therapist
  7. Social worker
  8. Clinical psychologist

  9. The characteristics of a multidisciplinary team:
    • Discipline specific goals
    • Progress is communicated through documentation and regular team meetings – it is therefore important to encourage meetings between the team members on a regular basis
    • The attending-physician is generally the team leader

The Acute Phase[edit | edit source]

The acute phase of spinal cord injury takes place immediately after the injury. [4] and it is the phase before rehabilitation. Initially the patient is immobilized to minimize the damage to the spinal cord and treatment commences to obtain and maintain physiological stability. During this time, the patient is often moved from the emergency room to the operating room to the ICU or appropriate unit.

The Role of the OT in SCI[edit | edit source]

“Regardless of the physical ability of a person with SCI, he or she can still be in control of directing others to assist in this task unless the person with the SCI is cognitively or intellectually impaired” (Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals (Consortium for Spinal Cord Medicine, 2000). )

Preventing Secondary Complications[edit | edit source]

Skin Management[edit | edit source]

Respiratory Complications[edit | edit source]

Joint Contractures[edit | edit source]

Mobilisation[edit | edit source]

Retraining for Activities of Daily Living[edit | edit source]

Psychological Support[edit | edit source]

Resources[edit | edit source]

  • bulleted list
  • x

or

  1. numbered list
  2. x

References[edit | edit source]

  1. ↑ 1.0 1.1 Burns AS, Marino RJ, Kalsi-Ryan S, Middleton JW, Tetreault LA, Dettori JR, Mihalovich KE, Fehlings MG. Type and Timing of Rehabilitation Following Acute and Subacute Spinal Cord Injury: A Systematic Review. Global Spine J. 2017 Sep;7(3 Suppl):175S-194S.
  2. ↑ Burns AS, Marino RJ, Flanders AE, Flett H. Clinical diagnosis and prognosis following spinal cord injury. Handb Clin Neurol. 2012;109:47-62.
  3. ↑ Rodríguez-Mendoza B , Santiago-Tovar PA , Guerrero-Godinez MA , García-Vences E. Rehabilitation Therapies in Spinal Cord Injury Patients. In: Arias, J. J. A. I. , Ramos, C. A. C. , editors. Paraplegia [Internet]. London: IntechOpen; 2020 [cited 2022 Aug 25]. Available from: https://www.intechopen.com/chapters/72439
  4. ↑ Alizadeh A, Dyck SM, Karimi-Abdolrezaee S. Traumatic Spinal Cord Injury: An Overview of Pathophysiology, Models and Acute Injury Mechanisms. Front Neurol. 2019 Mar 22;10:282.
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